Shelley Hiroko Miyasaki, D.D.S., PH.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

35147 Issued in CA

Practice address

4150 Clement St
Dental Service Mail Stop #160
San Francisco, CA 94121-1545

Phone

(415) 221-4810

Fax

(415) 750-6603

NPI assigned

Jun 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1750325130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 CLEMENT ST",
            "address_2": "DENTAL SERVICE (160)",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941211545",
            "telephone_number": "415-221-4810",
            "fax_number": "415-750-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 CLEMENT ST",
            "address_2": "DENTAL SERVICE MAIL STOP #160",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941211545",
            "telephone_number": "415-221-4810",
            "fax_number": "415-750-6603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYASAKI",
        "first_name": "SHELLEY",
        "middle_name": "HIROKO",
        "name_prefix": "Dr.",
        "credential": "D.D.S., PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "35147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rima Sueishi Miyagawa, AMFT
• Edith Miyaki, RN, MS
• Jason Miyamoto, MS ATC
• Kanako Miyamoto
• Leigh H. Miyamoto, MD
• Heather Leigh Miyashiro, NP
• Miyoko Miyata, LAC DNBAO
• Saori Miyazaki Maeshiro, MFT
• Yurio Miyazawa
• Lauren M. B. Mizock, PHD

• Oral and Maxillofacial Surgery (Dentist) in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.